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John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Today I was talking with a healthcare IT vendor which really needs to integrate deeply with an EHR to be valuable. Without that integration the product is not nearly as useful for doctors. Therefore we started talking about their current EHR integration and the potential for future EHR integrations. At that point he asked me what I thought about the coming Epic App Store (officially called the Epic App Exchange).

In case you missed it, I wrote about the Epic App Store over on Hospital EMR and EHR. I cover what’s been said about the Epic App Store (not much from Epic itself) and make some predictions. However, today’s conversation solidified my predictions.

Epic has always been open to working with their customers and a tech partner to integrate something with Epic. Basically, the customer is king and so if the customer wants the integration, Epic will provide the SDK that’s needed for the integration and make it possible for the customer to do what they need. Everyone’s known that if you want to integrate with Epic, then you need to work through a customer.

With this in mind, I believe the Epic app store is a way for Epic to allow for distribution of these apps that have been created by their customers (often with a tech partner) to other Epic customers.

Basically, this is in line with Judy’s focus on the customer. Some might say that this focus is great. Hard to argue with Epic’s success. However, this approach misses out on the opportunity of the Epic app store facilitating entrepreneurial innovators to build something on top of Epic that their customers didn’t even know they wanted yet.

Epics current strategy is more in line with staying the entrenched incumbent. Real transformation comes when you provide a platform for innovation that goes beyond yourself and your customers. I hope one day Epic sees this vision and really roles out an open app store. Until then, the Epic connected customer applications are going to have a bit of a monopoly selling their add on services to Epic customers.

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I recently came across an interesting article in Entrepreneur magazine authored by Girish Navani, CEO and Co-founder of eClinicalWorks. If you read this site, you know doubt are familiar with the quite popular eCW EHR software. In this article Girish gives some interesting insight into the future of eCW as a company:

After grad school, I set out to create my own version of my father’s bridge. After working many odd jobs developing software, I created credit check software for an acquaintance’s business. This made him a lot of money, which prompted me to ask (perhaps naively) for a share of the profit. I had developed a very successful facet of the company – didn’t I deserve it? His response surprised me, but I will never forget it. He said, “If you build something you like, don’t sell it.”

Twenty years later, I still remember my acquaintance’s advice. For that reason, my company, eClinicalWorks is, and always will be, a privately-held company. I have no interest in selling it, regardless of any offer I may get. In addition, we don’t use investor cash or spend money we don’t have.

This is not a philosophy that is unique to eCW. #1 on Epic’s list of principles is “Do not go public.” I imagine that Judy Faulkner (CEO of Epic) has a somewhat similar philosophy to Girish. There are certainly a lot of advantages to not going public and most of them get down to control. I’ll never forget when I heard one of the Marriott children talk about their decision to stay a private company. He said that Marriott would likely be a lot bigger if they had become a public company, but they would have lost a lot of the company culture if they’d chose to do so.

I imagine this is a similar feeling that Epic and eCW share. However, there’s also some accountability that comes with being a public company as well. It’s not easy for an organization to assess the financial well being of a private company. During the golden age of EHR which we just experienced, that hasn’t been an issue for either eCW or Epic. However, as we exit this golden age of EHR that was propped up by $36 billion in government stimulus money, the financial future may be quite different.

As in most things in life, there are pros and cons to staying private or going public. It’s interesting that two of the major EHR players (eCW and Epic) have made it clear that they have no interest in ever going public. We’ll see how that plays out long term.

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

This week has been the annual user group for Epic EHR users, otherwise known as Epic UGM. @VinceKuraitis aptly noted that the Epic user conference had 15k attendees and yet it only produced 188 tweets the first day of the conference. I’m not sure if this is a reflection of Epic users view of social media or Epic users fear of sharing what’s happening. The limited tweets aside, there were still a number of interesting tweets and pictures coming out of the event. Plus, some interesting quotes from the Madison paper I think you’ll enjoy.

Look at the crowds for registration. I wonder when Epic will outgrow Madison and need to move the event to Las Vegas. We’d certainly welcome them here. Although the local paper said that the event is the second biggest tourism engine in the area (World Dairy Expo beats it out).

Deep Space was the theme of the conference and also is the name of the enormous 11,400 seat underground auditorium on Epic’s campus. More pictures of the auditorium below. It’s also worth noting that Judy did the keynote dressed as a Na’vi from the movie “Avatar.”

Soon the Epic conference will pass HIMSS on attendance. Not likely, but it is interesting that there were only 297 healthcare organizations. I wonder how many people organizations like Kaiser brought to the event.

#EpicUGM Judy says ONC should pause five years between MU Stages 3 and 4 to evaluate…interesting take.

This is a really interesting tweet. First, it’s interesting that Judy is talking about meaningful use stage 4. Does this mean there will be an MU stage 4? Second, what happened to MU stage 2? I’m pretty sure most aren’t worried much beyond MU stage 2 right now.

This likely deserves a blog post of its own. Although, this comment is really interesting in the context of Epic. Does this mark a fundamental shift in the products that Epic develops?

What I think will be the biggest announcement coming out of Epic UGM 2013 is the new Epic API. While it definitely falls short of what most of us would love to see Epic do with an API, at least it’s a start. The focus of the API seems to all be around getting all of the various health and wellness app data into the EHR. Here’s a good description of who they want to use the Epic API:

Are you a manufacturer of a consumer-facing monitoring device? We have an API for that.

Have you developed a health or wellness-related tracking app or portal? Clinicians need that information.

We’ve designed open.epic to make it gosh-darn simple to integrate the data you collect into your patients’ medical records. Interested?

I believe this will be a great opportunity for many developers. We’ll see how it plays out long term. I’m a little surprised that the Epic API doesn’t include interoperability which Epic is doing more and more. I guess they see it as a separate initiative.

The local newspaper covered the Epic UGM event as well and offered a few other insights into what was said at the conference:

“We’ve just gone over the 51 percent mark. You take care of a little over half of the patients in this country,” Faulkner said. Worldwide, nearly 2.4 percent of the population is covered by electronic health records created by Epic.

Epic, with $1.5 billion in 2012 revenue and 6,800 employees, will keep growing as its customers grow, Faulkner said, adding that clients are loyal. “To us, it’s a lifetime relationship,” she said.

I think Judy might be right for many Epic customers. The lock in to Epic for many of these large organizations is strong.

I guess the 15,300 attendee number is interesting when you think that 6,800 of them could be employees. Although, no doubt it is a really important and interesting event in the healthcare IT world. Judy seems to be softening on media coverage of Epic. It seems like Judy and Epic have decided to start becoming a larger part of the conversation. I wonder if a blogger could attend the event next year.

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Yesterday I had a video interview scheduled with Jonathan Bush from athenahealth. It was going to be broadcast live on my burgeoning EHR Videos website (Subscibe for EHR Video Email Updates) using the Google Plus Hangout technology. Everything was set until Google Plus HOA (Hangouts On Air as they’re called) wouldn’t load. It was a system wide problem and so we were unable to broadcast the interview. However, Jonathan and I were able to see each other and so we just did a more traditional interview about the subject of open vs closed EHR systems.

As you can imagine Jonathan had plenty to say on the subject of open versus closed EHR systems. We started the discussion discussing the business model of closed EHR systems and how looking at many EHR companies that seemed to be a very good business model. I asked him what was so bad about being closed.

Jonathan then told me that a closed EHR system is a great business model for the software vendor if you can get it. However, he said that as the product category matures the closed systems will get disrupted by more open options. In fact, at one point in our conversation he suggested that once some of the players become truly open, the other EHR vendors will have to follow along.

I was offered one caveat by Jonathan. He was curious if Epic was the exception to this rule. He wondered if Epic had so much money that they could last well beyond most companies. This cash could provide them the runway and opportunity to reinvent themselves along with those companies trying to disrupt them. Although, the most powerful comment made in regards to Epic was when he suggested that Epic has clients that benefit from Epic’s closed nature as well.

Another powerful comment he made was, “Affordable sounds like decline.” The concept is really interesting. Basically, so many EHR vendors have been able to charge an outrageous premium with amazing margins for their EHR software. If they were to choose to lower their price, many could misinterpret that decision as the company cutting prices to increase sales that have dropped off. Certainly the argument can be made that EHR vendors don’t need to charge what they do. However, image is important and could be influenced by a price drop.

While it’s always fun to talk about Epic with Jonathan, I also pressed him on why athenahealth wasn’t more open in the things they do. Couldn’t some of the same arguments made against closed EHR systems be applied just as easily to athenahealth? For example, why isn’t the athenahealth API more open?

In one of his more contemplative responses, Jonathan acknowledged that athenahealth was heading down the path of closed EHR systems. He saw that they were headed in a similar direction with their business model and so they had to decide if that’s the direction they wanted to continue or if they wanted to move towards a more open EHR model. He mentioned their More Disruption Please program and how the number of companies they were working with in that program was a sign of their move to be more open.

Jonathan admitted that the athenahealth API wasn’t where it should be, but that the goal was to have an API for every surface area of athenahealth. I wish we had this comment on video so we could really hold him to it. I love the idea of every surface area of an EHR being available through an API.

I also pressed Jonathan a little bit about CommonWell and whether it would be open to everyone and anyone that wanted to participate. He responded, “We expect every single maker of health information technology to obtain a key for every patient they have and see where that patient has been.” That was a pretty broad statement about openness. He did suggest that CommonWell was the right approach of knowing where the data was stored as opposed to storing every single person’s data in every clinic. It had to be a distributed patient records model.

Jonathan did also tell me that they’d recently got a call from Epic to work with them to build API connections with all the information in Epic. We’ll see if this is a step towards a more open Epic. Although, it still seems to follow the same pattern Judy discussed when she called Epic the most open EHR system she knew. She’s ok opening up with strategic partners.

I ended the conversation with me asking Jonathan what could be done to make the business model of being open work in healthcare. He mentioned two topics that deserve more time and their own dedicated post: a repriced athenaclinicals based on order and anti kick back laws as an obstacle for exchange of information. Both were preventing a market for health information. Our time ran out so I couldn’t dig into these subjects more. I’m going to see if Jonathan or someone from athenahealth would be willing to do a couple future guest blog posts on the subject.

As you can see, I covered a lot of ground with Jonathan in the 10 minutes we had. Imagine if we’d had the full 30 minutes. Plus, you could have heard it straight from him. I’m certain we’ll be inviting Jonathan back for another interview in our series of EHR Videos.

Free EMR Newsletter Want to receive the latest news on EMR, Meaningful Use,
ARRA and Healthcare IT sent straight to your email? Join thousands of healthcare pros who subscribe to EMR and HIPAA for FREE!

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We never sell or give out your contact information. We respect our readers' privacy.